Post op and pre-op
alterations in psychological function post op - - anxiety and depression- radical surgery, poor
prognosis, changes in living
- confusion and delerium- medications, anesthetic, opioids, dehydration, infection, identify
factors that may cause
Alterations in temperature post op - up to 12 hours: hypothermia (36) due to anesthesia and
loss in surgical exposure
- 24-28 hours: elevation to 38 due to atelectasis or inflammatory response
- 3rd day: above 37.7- infection, phlebitis
- assess every 4 hours on first day and if everything is fine by day 2= morning and every shift
change
- meticulous asepsis for wound and IV
- encourage airway clearance
- investigate cause of fever - wound, urine, head to to, inform doctor, chest x-ray, cultures,
leukocyte level
Before leaving the room post-op - - call bell in reach
- emesis basin and tissue in reach
- ice chips + sips of water if allowed
- warm blankets and flannel sheets
Cardiovascular system Pre-op - - vitals recorded as a baseline
- bleeding/clotting times
- lab reports
- ECG, cardiac vital signs
- report problems for effective monitoring, use of cardiac drugs, presence of pacemaker,
myocardial infarction
,3 causes of DVT - 1- venous stasis- venous valves/muscles can't maintain upward push,
immobilization, elderly, heart failure, obesity, pregnancy, orthopaedic surgery
2- endothelial damage- inner lining of view caused by trauma or venipuncture, high BP, incision,
medication, IV, poking, IV abuse, femoral vie cath, trauma, inflammation
3- hypercoagulability- hematologic disorders and other circumstance, smoking, a-fib, meds,
dehydration, contraceptives, sepsis, severe anemia
Abdominal surgery considerations post op - - NPO until bowel sounds are present
- IV infusions to maintain fluid and electrolyte balance
- N/G tube may be used to decompress +suction
- resuming oral intake: 1- clear fluid 2-full fluid, 3- soft diet, 4- regular diet, 5- special diets
Accurate intake and output post op - - verify fluid balance from OR and PACU records- all fluids
throughout surgery and transfer to your record= more accurate
- always include estimated blood loss
Acute urinary retention post op - anesthesia depresses nervous system including micturition
reflex arc and higher enters that affect it = bladder fills more than normal before the urge is felt
- abdominal or pelvic surgery causes spasms, gaurding, and interferes with normal functioning
- bladder and prostate surgery= obstructed flow
- immobility and recumbent positions in bed = lack of skeletal muscle activity decreases smooth
muscle tone, supine = inability to relax perineal muscles and external sphincter
age related pre-op - - physiological condition, not just chronicle age
- paticularly alert for older clients: an event with little impact on younger has a big impact on
older (greater overall risks)
, Allergies - - drugs and non drugs
- latex
cardiovascular- fluid deficit - - inadequate fluid replacement= decreased cardiac output and
tissue perfusion
- hypovolemic shock
cardiovascular- fluid excess - - due to stress response and compensation for fluid loss during
surgery (RAAS)= fluid and sodium retention
- IV fluids too rapidly
- older patient, or chronic cardiac and renal disease
collaborative care plans - - interprofessional
- specific to surgery
- outlines expected course
- length of stay
- potential problems
- printed orders
- guidelines
- components of critical path- consults, teachings, tests, treatments, meds, diet, activity,
discharge planning, expected patient outcomes
consent for surgery - - surgeon is responsible to obtain (may appoint to the nurse to witness and
obtain)
- verify the client's understanding
- client's permission can be withdrawn at any time
alterations in psychological function post op - - anxiety and depression- radical surgery, poor
prognosis, changes in living
- confusion and delerium- medications, anesthetic, opioids, dehydration, infection, identify
factors that may cause
Alterations in temperature post op - up to 12 hours: hypothermia (36) due to anesthesia and
loss in surgical exposure
- 24-28 hours: elevation to 38 due to atelectasis or inflammatory response
- 3rd day: above 37.7- infection, phlebitis
- assess every 4 hours on first day and if everything is fine by day 2= morning and every shift
change
- meticulous asepsis for wound and IV
- encourage airway clearance
- investigate cause of fever - wound, urine, head to to, inform doctor, chest x-ray, cultures,
leukocyte level
Before leaving the room post-op - - call bell in reach
- emesis basin and tissue in reach
- ice chips + sips of water if allowed
- warm blankets and flannel sheets
Cardiovascular system Pre-op - - vitals recorded as a baseline
- bleeding/clotting times
- lab reports
- ECG, cardiac vital signs
- report problems for effective monitoring, use of cardiac drugs, presence of pacemaker,
myocardial infarction
,3 causes of DVT - 1- venous stasis- venous valves/muscles can't maintain upward push,
immobilization, elderly, heart failure, obesity, pregnancy, orthopaedic surgery
2- endothelial damage- inner lining of view caused by trauma or venipuncture, high BP, incision,
medication, IV, poking, IV abuse, femoral vie cath, trauma, inflammation
3- hypercoagulability- hematologic disorders and other circumstance, smoking, a-fib, meds,
dehydration, contraceptives, sepsis, severe anemia
Abdominal surgery considerations post op - - NPO until bowel sounds are present
- IV infusions to maintain fluid and electrolyte balance
- N/G tube may be used to decompress +suction
- resuming oral intake: 1- clear fluid 2-full fluid, 3- soft diet, 4- regular diet, 5- special diets
Accurate intake and output post op - - verify fluid balance from OR and PACU records- all fluids
throughout surgery and transfer to your record= more accurate
- always include estimated blood loss
Acute urinary retention post op - anesthesia depresses nervous system including micturition
reflex arc and higher enters that affect it = bladder fills more than normal before the urge is felt
- abdominal or pelvic surgery causes spasms, gaurding, and interferes with normal functioning
- bladder and prostate surgery= obstructed flow
- immobility and recumbent positions in bed = lack of skeletal muscle activity decreases smooth
muscle tone, supine = inability to relax perineal muscles and external sphincter
age related pre-op - - physiological condition, not just chronicle age
- paticularly alert for older clients: an event with little impact on younger has a big impact on
older (greater overall risks)
, Allergies - - drugs and non drugs
- latex
cardiovascular- fluid deficit - - inadequate fluid replacement= decreased cardiac output and
tissue perfusion
- hypovolemic shock
cardiovascular- fluid excess - - due to stress response and compensation for fluid loss during
surgery (RAAS)= fluid and sodium retention
- IV fluids too rapidly
- older patient, or chronic cardiac and renal disease
collaborative care plans - - interprofessional
- specific to surgery
- outlines expected course
- length of stay
- potential problems
- printed orders
- guidelines
- components of critical path- consults, teachings, tests, treatments, meds, diet, activity,
discharge planning, expected patient outcomes
consent for surgery - - surgeon is responsible to obtain (may appoint to the nurse to witness and
obtain)
- verify the client's understanding
- client's permission can be withdrawn at any time
